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A BILL TO BE ENTITLED
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AN ACT
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relating to nonpayment of hospitals under the state Medicaid |
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program for certain preventable adverse conditions. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter B, Chapter 32, Human Resources Code, |
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is amended by adding Section 32.02805 to read as follows: |
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Sec. 32.02805. NONPAYMENT OF HOSPITALS FOR PREVENTABLE |
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ADVERSE CONDITIONS. (a) The department in its adoption of |
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reasonable rules and standards governing the determination of rates |
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paid for inpatient hospital services on a prospective payment basis |
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shall assure that a hospital may not receive additional payment |
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associated with any of the following preventable adverse conditions |
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involving a recipient of medical assistance during the recipient's |
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hospitalization: |
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(1) a foreign object retained after surgery; |
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(2) surgery performed on the wrong body part; |
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(3) surgery performed on the wrong person; |
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(4) the wrong surgical procedure performed on the |
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recipient; |
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(5) intravascular air embolism; |
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(6) blood or blood product incompatibility; |
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(7) a stage three or four pressure ulcer; |
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(8) a fall or trauma resulting in a fracture, |
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dislocation, intracranial injury, or crushing injury; |
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(9) a burn or electric shock; |
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(10) a catheter-associated urinary tract infection; |
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(11) a vascular catheter-associated infection; |
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(12) a manifestation of poor glycemic control, |
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including diabetic ketoacidosis, nonketotic hyperosmolar coma, |
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hypoglycemic coma, secondary diabetes with ketoacidosis, and |
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secondary diabetes with hyperosmolarity; |
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(13) a surgical site infection or mediastinitis |
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following a coronary artery bypass graft; |
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(14) a surgical site infection following certain |
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orthopedic procedures of the spine, neck, shoulder, or elbow; |
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(15) a surgical site infection following bariatric |
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surgery for obesity, including laparoscopic gastric bypass |
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surgery, gastroenterostomy, and laparoscopic gastric restrictive |
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surgery; and |
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(16) deep vein thrombosis and pulmonary embolism |
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following certain orthopedic procedures, including total knee |
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replacement or hip replacement. |
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(b) The executive commissioner of the Health and Human |
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Services Commission may adopt rules to define additional |
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preventable adverse conditions for which a hospital shall be denied |
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additional payment under this section. In adopting rules under |
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this subsection, the executive commissioner may consider only the |
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same types of health care-associated adverse conditions or events |
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for which the Medicare program will not provide additional payment |
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under a policy adopted by the Centers for Medicare and Medicaid |
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Services. |
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(c) The department's nonpayment of a hospital under this |
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section does not in itself create civil liability and is not subject |
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to discovery or admissible in any civil action against the |
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hospital. |
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(d) The Health and Human Services Commission shall compile |
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information regarding the denial of payment to hospitals under this |
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section. |
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(e) The Health and Human Services Commission shall make |
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statistical information derived from the data compiled under |
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Subsection (d) readily available in a user-friendly format on the |
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commission's website. |
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(f) The Health and Human Services Commission may not provide |
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information under Subsection (e) in a manner that identifies a |
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recipient of medical assistance. |
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SECTION 2. Not later than November 1, 2009, the executive |
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commissioner of the Health and Human Services Commission shall |
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adopt rules necessary to implement Section 32.02805, Human |
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Resources Code, as added by this Act. |
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SECTION 3. Section 32.02805, Human Resources Code, as added |
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by this Act, applies only to a preventable adverse condition |
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occurring on or after the effective date of the rules adopted by the |
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executive commissioner of the Health and Human Services Commission |
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under Section 2 of this Act. |
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SECTION 4. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 5. This Act takes effect September 1, 2009. |